Chris Ham: Statesmanship among medical leaders could help resolve the junior doctors’ dispute

April 18, 2016

Whatever the rights and wrongs of the standoff between the government and junior doctors, failure to reach agreement on a new contract is bad for patients and for staff. The all out strike planned for the end of the month will cause disruption and delay for patients, and add to the pressures on staff who cover for absent colleagues. It will also create dilemmas for junior doctors torn between loyalty to their peers and their primary—and strongly felt—duty to patients.

The dispute may also affect recruitment into medicine and the willingness of newly qualified doctors to practise in England. It will have an impact too on the discretionary effort of junior doctors who form the backbone of patient care throughout the NHS. We know that patient experience is closely correlated with staff experience, and when a key group of staff is feeling undervalued patients will notice the difference.

The King’s Fund has intentionally not taken sides in a dispute in which total lack of trust between the two sides has been overlaid on outstanding differences on the contract itself. We are speaking out now to suggest a way of circumventing the impasse that has been reached, in the hope that a resolution may be found. Our suggestion is that the presidents of the royal medical colleges should reach out to the Prime Minister to offer their services in finding a way forward.

It might be objected that the royal medical colleges have no locus in negotiations about doctors’ contracts, which is firmly the responsibility of the BMA. This is, of course, correct but they do exercise leadership on standards of medical care and the training of doctors. There have also been occasions in the past when college presidents have seen fit to go beyond their formal responsibilities to make known their concerns.

This happened in 1987 when a crisis in NHS funding led three of the most senior college presidents to call on the government of the day to take action in protecting patient care. The dispute over the junior doctors’ contract is different, but it is beginning to affect patient care and if it continues the consequences could become much more serious. Already there are shortages of doctors in some specialties and a prolonged dispute risks accentuating these shortages.

When two sides disagree so fundamentally, intervention by a respected third party is necessary. In this case the college presidents are well placed to take on this role if they can find the will to take the initiative. Statesmanship among medical leaders is needed now more than ever. Patients deserve nothing less.

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